But as things would have it, the ACP blog does not permit the "html" tag in his blog comments (I understand why: it helps limit blog spam), but I wanted to reference a few important links so I'm placing my different "honest" assessment of our law's second week here. So Bob, please excuse my comment being left here.
Politics and medicine don't mix, yet today the two combined are our reality. As such, a brief comment about your post.
First on what we agree upon: tech problems on healthcare.gov are not a reason to declare the ACA a “failure.” No doubt the day will come after they pour in many tens of millions of dollars more to fix the website that things will be humming along famously one day.
But many are aware that the ACA as it was written is no longer the ACA, so as such, it has failed before it's website was launched. But if we ignore this fact, the ACA now is a patchwork of political favors and waivers that favors the politically connected and architects of the law and it is likely to continue to be such. We are also finding that the law is very expensive for many Americans, yet does little to address the expanding cost burdens that health care imposes on America’s economy, especially when one evaluates the law on the basis of health care cost sustainability. To me, this is the ACA’s Achilles’ heel and why it will ultimately be morphed into yet another "law," not because of some poorly-designed website. You see, it is anything but “Affordable” and even more importantly, certainly not “sustainable.” But we should acknowledge that for many Americans saddled with the prospect of bankrupsy from burgeoning health care costs, the law will offer relief and this is a good thing.
Still, after the debut of the exchanges 1 October 2013, out-of-pocket costs of the new health care “plans” put forth by the insurance industry became known and were nicely outlined by Peter Frost in the Chicago Tribune recently. People will soon be feeling the effects of these additional costs first-hand that have been created in large part by the regulatory requirements of the law and its giant bureaucratic overhead. In fact, I have already begun hearing from patients that the deductibles for many of them are so high that many are worried they won’t meet their deductibles in an average health care year before the next year arrives. So what have they gained from this law, just a sense of altruism for their fellow man?
Personally, I think this is why the ACA as it exists will fail: Americans’ realized out-of-pocket health care costs. And when it does, Big Box medicine will have to accommodate new, innovative health care payment strategies that actually create visible value to those who pay into the system, rather than just guaranteeing the rising stock price of insurance and pharmaceutical companies.
But physicians like us are also to blame for the law’s ultimate failure. Caught between the law’s political promise of "health care coverage for all" now, versus creating more sustainable health care delivery system for the long run, our political lobbying groups (the AMA, ACP, ACC and others) sided with the political expediency of approving the law’s construct as it was presented. And so now, we have no choice but to continue to ride along on our newly revised Healthcare Hindenburg whether doctors really like it or not.
Just my two cents.